Is Adding Fibrinogen Concentrate to Transfusion Therapy for Postpartum Hemorrhage an Effective Approach?
Significant postpartum hemorrhage can be managed with fresh frozen plasma transfusion. However, administering larger volumes is associated with several risks. The authors of the Japanese study below investigated whether fibrinogen concentrate added to fresh frozen plasma transfusions is an effective tool in reducing the need for erythrocyte concentrate and whether it helps prevent complications of intensive transfusion therapy.
Introduction
Massive bleeding accompanying childbirth remains a leading cause of maternal mortality. Some of these hemorrhages are associated with hypofibrinogenemia. To normalize fibrinogen levels using fresh frozen plasma (FFP) transfusion, multiple units must be administered, which burdens the patient's circulation and in many situations may still be insufficient.
Retrospective Study
The authors focused on comparing the effect of FFP administered alone to its combination with fibrinogen concentrate (FFP + Fib) in women with massive postpartum hemorrhage. The outcomes of patients from real clinical practice treated between 2004 and 2016 were compared. This included 137 women with fibrinogen levels < 1.5 g/l. Among them, 47 women treated after August 2009 received both FFP + Fib and 56 women treated before this period received only FFP.
Results
Coagulation parameters before the onset of transfusion therapy, estimated blood loss, and the number of administered erythrocyte concentrate units (erythrocytes) did not significantly differ between the two groups.
The FFP/RCC (erythrocyte concentrate transfusion unit) ratio was significantly lower in the group treated with FFP + Fib. A sub-analysis of 39 cases requiring ≥ 18 units of erythrocytes showed that less FFP was administered in the group treated with FFP + Fib (40.2 ± 19.6 vs. 53.4 ± 18.5 units; p = 0.047). Additionally, pulmonary edema was significantly less frequently observed in this group (24.0 vs. 57.1%; p < 0.05).
Administration of fibrinogen concentrate led to approximately a 5-fold faster increase in fibrinogen levels, a reduction in the need for FFP transfusions, a decrease in the FFP/erythrocytes ratio, and a lower incidence of pulmonary edema. Furthermore, no thrombosis was recorded in this group of women.
Conclusion
The results of the cited study suggest that adding fibrinogen concentrate to FFP in the treatment of massive hemorrhage associated with childbirth may enhance the chances of effectively managing this very serious complication.
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Source: Matsunaga S., Takai Y., Nakamura E. et al. The clinical efficacy of fibrinogen concentrate in massive obstetric hemorrhage with hypofibrinogenemia. Sci Rep 2017; 7: 46749, doi: 10.1038/srep46749.
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